Wednesday, November 14, 2012

Not this one!

I’ve written in brief about my cervical cancer patients
previously. The problem with cervical cancer is that usually by the time you
have any symptoms, it has gone to far to be able to offer any good treatment. In
the states, pap smears are so engrained
and routine, we often catch the cancer early. Here, they always come in
advanced. I diagnose it as they walk in the door. The smell of rotting flesh
has no obvious source as they walk in, so that tells me exactly where the
source is. I don’t even shy away anymore from the smell, don’t grimace during
the exam. That seems degrading to someone who you are about to give very bad
news to. The exam is the same, black and gray flesh where pink should be,
overtakingly malodorous discharge pouring out, and dull eyes peering over the
pelvic bones wondering what I am seeing down there. I finish, and cover their
legs again. I keep them lying flat to help taper the trickle of bleeding that
ensues after the most gentle exam I can perform. And I draw my chair up beside
them to talk face to face. I tell them that the cancer is too big, and that I
have no way to cure it. No one has any way to cure it. I have some “special
x-rays” (an old cobalt radiation machine) available 6 hours away, but it won’t
cure the cancer. It can help with the pain or the bleeding, but that is all.
But she can’t afford it anyways. It may as well not exist as a false hope in
her world. I tell her that no matter what we do, this cancer is eventually
going to take her life. I answer any questions, and then I ask if I can pray
with her. I pray to a God who can be trusted in the best of circumstance, and
the worst of circumstance. She usually cries a little. I tear up too, but have
it under control by the time she opens her eyes at the finish of the prayer.
Then I send her to the chaplaincy to continue her counseling (they also do much
of the psychology here), and palliative care, who will supply her morphine
until she dies.

But not this week. Yesterday someone came in with the biopsy
results, “invasive cancer” it read. She had been screened at an outside
screening progam. She didn’t smell bad. And the cervix was still visible. In
fact, the area was small. I knew it was small enough. Small enough to give
another talk, instead of the usual one. I finished the exam, all of it was
clear otherwise. I cursed the cancer to myself, “you can’t have this one”.

But that isn’t the really amazing part. In just a few hours
I knew that walking into my clinic would be the doctor from Canada with whom I
will learn for the next week. I know of no one else who has done so many cancer surgeries here. Next week, we are doing cervical cancer surgery together so
that I can learn the procedure better. I assisted on a few in residency, but
not enough to feel like my patients would really get the best surgery if I
tried to do it alone. But he has done this many times. And he has travelled the
country over the past days, from one screening center to the next, rounding up
only the handful of women who are eligible for surgery amongst the swarms of
inoperable. Only a few drops of hope in the midst of a sea of despair, but a
few beautiful drops.

This lady was the only one from our hospital region who qualified
for the surgery. She came in randomly on that day. This doctor came randomly on that day too. Apparently, others have been waiting on him for months. And now,
she is to meet us next week for surgery. Seemingly random events, but actually
very amazing. Why do so many die, and yet the paths have come together so well for
her? I don’t know. But still, I pray to a God who can be trusted in every
circumstance. And I pray that the hope I have seen in her will be lived out in
life instead of death this time. That her children will get to keep her. And
she will die at some ripe old age, filled up with days. But more, that she will
understand, at least as I see it, that there is some divine hand working for
her good. And that her life lived will be lived for His glory.